Provider Demographics
NPI:1629122999
Name:DILLON, MARIKA J (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIKA
Middle Name:J
Last Name:DILLON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32457-0384
Mailing Address - Country:US
Mailing Address - Phone:850-250-2579
Mailing Address - Fax:813-262-0999
Practice Address - Street 1:304 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1846
Practice Address - Country:US
Practice Address - Phone:850-250-2579
Practice Address - Fax:813-262-0999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091061101YM0800X
FL13932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health